Obamacare Ingabe i-ACA; Ukwandiswa kwe-Medicaid Kuyingxenye yokuzibandakanya
Ngokomthetho, u- Obamacare uyisidlaliso nje soMthetho Wokunakekelwa Onganakekelwayo. Ekuqaleni yayisetshenziselwa umqondo we-pejorative ngabaphikisi bomthetho, kodwa uMongameli Obama wabamba lesi sigama ngo-2012, futhi sekusetshenziselwa kusukela kokubili abaphikisi nabasekeli be-ACA.
Njengoba i-Obamacare ifana ne-ACA, ihlanganisa zonke izinguquko zokulawula ezisebenza emakethe yomshuwalense wezempilo ngamunye (kokubili nokushintshaniswa , zonke izinhlelo ezintsha zezokwelapha zihambisana ne-ACA), kanye nezinguquko ezisebenza izimakethe ezincane nezimakethe ezinkulu.
Iphinde ifaka ukukhuliswa kweMedicaid, okuyinto eyinhloko ye-ACA. Futhi kuhlanganisa igunya lomuntu ngamunye kanye nezigunyazo zomqashi-i-ACA's "stick" ukukhuthaza abantu ukuba bathole ukukhokhelwa-kanye nezinsizakalo ze-premium-"izaqathe" -ukuthi ukukhokhela kungabizi kakhulu emakethe yomshuwalense wezempilo.
Nakuba abameli beRipublican kanye noHulumeni lweTrump baxoshe ukuxoshwa kwezingxenye eziningi ze-ACA kulo lonke u-2017, ingxenye eyodwa kuphela yomthetho owagcina isuswe kwaba yisigwebo somuntu ngamunye, futhi ukuchithwa ngeke kusebenze kuze kufike ngo-2019 . Inkokhelo yentela ye-GOP (uMthetho wokuThengiswa kwezeMali kanye neMisebenzi) owasungulwa ngoDisemba 2017 ekugcineni uzoqeda isijeziso somuntu ngamunye, kodwa inhlawulo izobe isadingeka (ngasekuqaleni kuka-2019) ekubuyiselweni kwentela yabantu abangaqinisekisiwe ngo-2018 .
Ngakho i-ACA ihlala ingapheli ngokuphelele ngo-2018, kanti izingxenye zayo cishe zizohlala zizinzile ngo-2019 nangaphezulu.
Ukusetshenziswa Okuvamile kwe "Obamacare" = Amalungiselelo Okuthengiswa Ngishintsha
Nakuba igama elithi Obamacare lihlanganisa ngokucophelela yonke i-ACA, abantu ngokuvamile bayisebenzisela ukubhekisela kumalungiselelo omshwalense wezempilo emakethe ngamunye athengiswa emakethe yomshuwalense wezempilo . Ngakho ngenhloso yalesi sihloko, sizohamba nokusetshenziswa kwegama, futhi sibuke umehluko phakathi kwalawo macebo kanye neMedicaid.
"I-Obamacare" izinhlelo ziyimigomo yangasese; I-Medicaid ihlanganisa ukuphathwa kukahulumeni
Umehluko obaluleke kakhulu phakathi kweMedicaid ne- Obamacare ukuthi izinhlelo zezempilo ze-Obamacare zinikelwa izinkampani zomshuwalense wezezimali ngenkathi iMedicaid uhlelo lukahulumeni.
I-Medicaid, uhlelo lomshuwalense wezempilo lukahulumeni lwezakhamuzi zase-United States ezingenayo imali ephansi, luhlelo lwezenhlalakahle olufana nezitembu zokudla ze-SNAP noma Imindeni Yesikhashana Emindeni Ehluphekayo.
Igama elithi Obamacare livame ukusetshenziselwa ukuchaza umshuwalense wezempilo wangasese owathengiwe ngemali yomshuwalense wezempilo ongenakuthembekile . Izinkampani zomshuwalense we-Obamacare zinikezwe izinkampani zomshuwalense wezempilo ezifana neBlue Cross, Kaiser Permanente, Molina, Aetna, Cigna, Wellpoint, nabanye. Izinhlelo zezempilo ze-Obamacare aziqhutshwa nguhulumeni, kodwa kufanele zihambisane nemithetho ehlukahlukene kahulumeni.
Kumele kuqaphele ukuthi, ngaphezu kwezinyanga ezintathu ze-Medicaid ezibhalisa kuwo wonke amazwe kuhlelo lokunakekelwa okwenziwe nge-Medicaid, okusho ukuthi umshuwalense wabo ulawulwa ngabashuwalense abazimele ababuye bathengise umshuwalense wezohwebo kubantu ngabanye namabhizinisi. Lezo zinhlelo zisebenza ngenkontileka nohulumeni kahulumeni ukunikeza izinzuzo zeMedicaid.
Lokhu kungadideka kubantu, futhi kuhlanganiswa ukuthi emazweni amaningi, uhlelo lweMedicaid alunayo "Medicaid" egameni layo (Apple Health eWashington, isibonelo, noBadgerCare Plus eWisconsin).
Ubani Otholwa Ngama-Medicaid? Ubani Othole I-Obamacare
Kunzima ukuthola iMedicaid kunokuba uthole uhlelo lwezempilo lwe-Obamacare.
Uma ungumhlali wezomthetho wase-United States, ungathenga uhlelo lomshuwalense wempilo yangasese ye-Obamacare ngokusebenzisa i-ACA exchange exchange yomshuwalense wakho uma nje ungafanelekile ku- Medicare . Uma imali yakho engenayo ingu-100% no-400% wezinga lobuphofu lombuso , ungase ufanelekele umxhaso osiza ukukhokha ingxenye yezinkokhelo zakho zomshuwalense wenyanga yenyanga (inothi ukuthi umgwamanda ophansi wokufaneleka kwezibonelelo zesikhwama sezingu-139% wezinga lobuphofu ekuthi ziye zandisa i-Medicaid; kulawo mazwe, i-Medicaid itholakala kubantu abanezinkokhelo ezingaphezulu kwamaphesenti ayisishiyagalombili wezinga lobuphofu).
Uma imali yakho engenayo ingaphezulu kuka-400% we-FPL noma ngaphansi kwama-100% we-FPL, ngeke uthole usizo lokukhokhela umshuwalense wezempilo odayiswe kuma-Obamacare ukushintshana, kodwa ungathenga uhlelo lwe-Obamacare noma kunjalo. Kulesi simo, uzoba nesibopho sokukhokha u-100% we-premium yenyanga. [Qaphela ukuthi abahambi basemthethweni-abanamali engenayo ngaphansi kwezinga lobuphofu banelungelo lokuthola izinsizakalo ze-premium uma bengakufanelekeli i-Medicaid ngenxa yezinyanga ezinhlanu zokulinda kwabafiki bakamuva.]
I-criteria yokuthola i-Medicaid iqinile futhi ihluka kusuka esimweni kuya kwesimo. Inhloso yangempela ye-ACA kwakuwukuthi bonke abahlali basemthethweni abanezinzuzo ezingaphezulu kuka-138% we-FPL bazothola ukukhokhelwa kwe-Medicaid mahhala. Kodwa-ke, isinqumo seNkantolo Ephakeme senza ngokuvumelana nalesi sigaba se-Care Affordable Care Act ngokuzithandela. Lokhu kuholele ohlelweni oludidayo lapho abanye abathi banesimo esiqinile sokufaneleka kwe- Medicaid ngoba abaholi babo bakhetha ukungakwazi ukwandisa ukuxilongwa kwe-Medicaid, kodwa ezinye izizwe zinezimo ezifanele kakhulu zokufaneleka ze-Medicaid ngoba abaholi bazo bakhetha ukungenelela kwe-ACA's Medicaid .
Kusukela ngo-2018, kunama-19 athi awazange akhulise i-Medicaid. Abantu abangaba yizigidi ezingu-2.4 ku-18 kulawo mazwe kukhona okubizwa ngokuthi igebe lokuhlanganisa: imali yabo engenayo isezansi kakhulu ekusizeni (ngaphansi kwezinga lobuphofu), kodwa futhi ayifanelekile kwi-Medicaid).
Uma uhlala esimweni esandise ukufakwa kwe-Medicaid, uzokwazi ukuthola i-Medicaid uma imali yakho engalungisiwe eguquliwe ingekho kuka-138% we-FPL. Lokhu kutholakala kwezidakamizwa kuvame ukukhululeka kuwe, nakuba abanye bathi bakhokhela i-premium yenyanga encane yokubhalela abantu abanenzuzo ngaphezu kwezinga lobuphofu.
Uma uhlala esifundeni esingakaze sandise ukuhlinzekwa kwe-Medicaid, kuzomele uhlangabezane nesilinganiso esidala sokufaneleka sokufaneleka. Lezi zinqubo eziqinile zihluka kusuka esimweni kuya kwesimo. Zihlanganisa inqubo ephansi yokuthola imali futhi ingadinga ukuthi ube yilungu leqembu elibhekene nezifo ezinengqondo njengabantu asebekhulile, abakhubazekile, abayizimpumputhe, izingane, abesifazane abakhulelwe, nabazali noma abanakekeli abadala abadala.
Ngakho-ke, isibonelo, uma ungenabantwana, oneminyaka engu-30 enempilo eneminyaka engu-30 enemali engenayo engu-R10 000 ngonyaka, noma ngabe ufanelekile yini ukuthola i-Medicaid kuncike kunoma yiliphi uhlala kulo. Uma uhlala endaweni esanda Ukuhlinzekwa kwezidakamizwa kuwo wonke umuntu owenza u-138% we-FPL, uzothola iMedicaid ngoba uhlangabezana nenqubo yokuthola imali. Uma uhlala esesimweni esingakhange sikhulise ukusabalaliswa kwe-Medicaid, ngeke ufanelekele i-Medicaid, nakuba imali yakho engenayo iphansi, ngoba awukhutshaziwe, usukhulile, uyimpumputhe noma ungumzali wengane encane (i-Wisconsin kuyinto ehlukile; isimo asizange samukele izimali zikahulumeni zokwandisa i-Medicaid, kodwa zinikeza i-Medicaid izakhamuzi ezinemali engenayo kuze kube sezingeni lobuphofu, ngakho-ke ayikho igebe lokuhlanganisa eWisconsin).
Isikhathi sokubhalisa esilinganiselwe se-Obamacare Vs. Bhalisa noma kunini isikhathi se-Medicaid
Abantu abafanelekile bangabhalisa ku-Medicaid unyaka wonke. Kodwa ukubhaliswa kwizinhlelo ze-Obamacare kutholakala kuphela ngesikhathi sokubhalisa ngonyaka ovulekile noma uma uhlangabezana nenqubo yokufaneleka yokuthola isikhathi esikhethekile sokubhalisa okukhethekile . Uma kungenjalo, kuzomele ulinde kuze kube yisikhathi sokubhalisa esilandelayo sokufaka isicelo se-Obamacare plan (inothi ukuthi lokhu kuyiqiniso kungakhathaliseki ukuthi ubhalisa ngokushintshanisa noma ukushintshaniswa; amacebo athengiswa ngaphandle kokushintshaniswa yi-ACA-ehambisanayo futhi, ube namafasitela okubhalisa okulinganiselwe okufanayo; i-Nevada iyinto ehlukile, lapho kusetshenziselwa khona izinhlelo zokushintshaniswa ngaphandle, kodwa ngezinsuku ezingu-90 zokulinda ngaphambi kokuqala kokusebenza).
Uma ufaka isicelo se-Obamacare plan ngesikhathi sokubhalisa okuvulekile (okuhleliwe ukugijima ukuwa ngalunye kusukela ngoNovemba 1 kuya kuDisemba 15), ukufakwa kokusebenza akusebenzi ukusebenza kuze kuJanuwari 1 wonyaka olandelayo. Isibonelo, uma ubhalisa ohlelweni lokubamba iqhaza ngesikhathi sokubhalisa okuvulekile ekwindla ka-2018, ukufakwa kohlelo lwakho lwe-Obamacare luzoqala ukusebenza ngoJanuwari 1, 2019 (kunemithetho ehlukile yokusebenza esebenza kahle kwezinye izimo lapho abantu befaka isicelo ngenxa isenzakalo esifanelekayo , njengokuzalwa kwengane).
Kodwa-ke, uma ufaka isicelo se-Medicaid futhi wamukelwa ohlelweni lweMedicaid, akukho sikhathi sokulinda ngaphambi kokuqala kokusebenza kwakho.
Ukubuyiswa okubuyiselwayo kwe-Medicaid Vs. Akukho Ukubuyiswa Okubuyisiwe kwe-Obamacare
Kwezinye izimo, ukusakazwa kwe-Medicaid kungabuyiselwa emuva. Isibonelo, uma unezinyanga ezingu-5 ukhulelwe uma ufaka isicelo futhi uthola ukuxilongwa nge-Medicaid, i-Medicaid ingase ikhokhele ngempela ukunakekelwa kokubeletha okutholile phakathi nezinyanga 1-4 zokukhulelwa kwakho, ngisho nangaphambi kokufaka isicelo se-Medicaid. Lokhu akulona iqiniso ngezinhlelo zomshuwalense wezempilo zangasese ezithengiswa kwi-Obamacare exchanges.
Kuyaphawuleka ukuthi i-Trump Administration iqale ukuvumela izicelo zokumisa ezivela ezizweni ezifuna ukuqeda ukubuyiswa okubuyiselwe ngaphansi kwe-Medicaid. Ngaphandle kokufakaza okubuyiselwayo, i-Medicaid iba ngaphezulu kakhulu kumshwalense wezempilo wangasese ngokuya lapho ukufakwa kokusebenza kungasebenza.
Izindleko eziphansi ezenzelwe ukuxilongwa Vs. Obamacare
Ezimweni eziningi, i-Medicaid ayidingi kakhulu endleleni yokukhokha imali , ukuqinisekiswa kwezimali noma ukukhishwa imali . Njengoba i-Medicaid ihloswe kulabo abanemali ephansi kakhulu, noma yini enye ngaphandle kokufaka uphawu oluncane lwezokwabelana ngezindleko ngeke kube yinto engenakulungiswa kwabamukeli be-Medicaid futhi balethe umkhawulo ongase ukwazi ukunakekelwa.
Ngakolunye uhlangothi, izinhlelo zezempilo ze-Obamacare ziza nezidakamizwa, ama-copayments, kanye ne-coinsurance. Njengoba i-deductible yama-dollar ayizinkulungwane ezimbalwa ingaba nzima kubantu abanemali ethobekile yokukhokha, kunesibonelelo sokunikezwa izindleko esitholakalayo kulabo abangenza ngaphansi kwama-250% we-FPL okusiza ukunciphisa izindleko zokwabelana ngezindleko. Labo abenza okungaphezu kwama-250% we-FPL banomthwalo wemali ephelele yanoma yikuphi ukwabelana ngezindleko okudingwa uhlelo lwezempilo lwabo lwe-Obamacare.
I-Medicaid & Medicare Ingahlanganiswa; Obamacare & Medicare Ayikwazi
Kusemthethweni ngokomthetho futhi kunenzuzo yokuba noMnyango wezeMpilo ne-Medicaid ngesikhathi esifanayo uma ufanelekile kokubili. Eqinisweni, kukhona ngisho negama labantu abanobabili: ababili bayakwazi .
Kodwa-ke, ngokuvamile akusizo inzuzo yokuba nombili umshwalense wezempilo wase-Obamacare no-Medicare. Akukho emthethweni kumshuwalense wangasese ukuthi akuthengise uhlelo lokuthengisa emakethe emva kokufaneleka kuM Medicare, nakuba bengenakukuphoqa ukuba ulahle uhlelo lwe-Obamacare osuvele unalo uma ufaneleka kuM Medicare. Kodwa uma kunjalo, uzolahlekelwa yinoma yimuphi umxhaso we-premium owamukelayo uma ufaneleka kuM Medicare, futhi akukho nokuhlanganiswa kwezinzuzo phakathi kweMedare kanye nemakethe ngayinye. Ngakho-ke kuvame ukululeka ukuthi abakwa-Obamacare ababhalise ukuyeka ukukhishwa kwabo ngabanye uma befaneleka kuM Medicare.
Qaphela ukuthi le nqubo ayilona othomathikhi; kufanele ukhansele kokuqala kwe-Obamacare yakho uhlele wena. Uma ufaneleka kuM Medicare, kuzodingeka uqondise ukwesulwa kwenqubomgomo yakho yomshuwalense we-Obamacare ngokuqala kokusabalalisa kwe-Medicare. Lokhu kuyiqiniso noma ngabe ubhalisela i-Medicare Parts A no- B , noma i-Medicare Part C, i-Medicare Advantage plan .
Kungani Ukutshela Ukuhlukana Phakathi Kokuxilongwa Ne-Obamacare Kungaba Nzima
Ukuqonda umehluko phakathi kwe-Medicaid ne-Obamacare kungadideka ngoba
- Ngokuvamile, ufunda ukuthi ufanelekile ku-Medicaid uma ugcwalisa isicelo somshuwalense wezempilo ku-ACA yakho yomshuwalense wezempilo. Uma ngabe ukushintshaniswa kunquma ukuthi ufanelekela i-Medicaid esifundazweni sakho, kuzothumela ulwazi kuloMedicaid, uqale inqubo yesicelo se-Medicaid. Njengoba usufake isicelo sakho somshuwalense wokuqala we-Obamacare yomshuwalense wezempilo, ungadideka uma usuqeda ukwamukela iMedicaid esikhundleni se-Obamacare plan yangasese.
- Nakuba i-Medicaid uhlelo lukahulumeni, emazweni amaningi, izinsizakalo ze-Medicaid eziningi zabhalisile zinikezwa ngenkampani yomshuwalense wezempilo yangasese. Eqinisweni, ngokusho kweKaiser Family Foundation, izingxenye ezingaphezu kwezingxenye ezintathu zezakhamuzi zaseMedicaid zilawulwa izinhlelo zokunakekelwa kwezempilo. Umzuzi we-Medicaid uthola ikhadi lakhe le-ID ye-Medicaid kusukela ku-UnitedHealthCare, Humana, Kaiser, noma i-Blue Cross, angase akhohlwe ngephutha ukuthi uthola umshuwalense wezempilo wakwa-Obamacare wangasese. Eqinisweni, uhlelo lwakhe lwama-Medicaid luye lwasebenzisana ne-insurer yangasese ukuze aphathe ukunakekelwa kwabamukeli be-Medicaid. Ngisho noma inkampani yangasese ilawula izinzuzo zeMedicaid, izinzuzo ngokwazo ziyiMedicaid futhi imali yokukhokha lezo zinzuzo ekugcineni zivela ekuhlanganiseni izimali zikahulumeni zentela kanye nombuso.
Njengoba iningi labantu elithenga umshuwalense wezempilo ku-ACA exchange exchange insurance uthole usizo lokukhokhela leyo inshuwalense yezempilo ngendlela yokuxhaswa nguhulumeni wesifundazwe, kungase kudideke ngokuthi umshwalense wezempilo wangasese okhokhelwa uhulumeni (Obamacare) ungubani ngempela okuhlukile kune-Medicaid.
> Imithombo:
> Amasevisi we-Medicare neMediicaid Services, Imibuzo Ebuzwa Ngokuphindaphindiwe Ngokuphathelene Nemithi NeMakethe . Agasti 1, 2014.
> Kaiser Family Foundation, I-Gap Coverage: Abadala Abangenalutho Emasimini Emazweni Angenwetshisi I-Medicaid. Novemba 1, 2017.
> Kaiser Family Foundation, Total Medicaid ephethwe Ukubhalisa Care, 2014.